Neighbourhood Health

Neighbourhood working brings both opportunities and risks for practices. This page explains what is changing, where the BMA and BLMC stand, and the questions worth asking before your practice or PCN commits to a local proposal.

Current position

NHS England’s consultation on the two proposed neighbourhood contracts closed on 10 September 2026. Firmer proposals and a further consultation are expected later this year. BLMC’s position and the questions to ask of any local proposal are set out below.

Sources: NHS England consultation on proposed contracting models; BMA and GPC England updates to LMCs, August 2026.

You do not have to sign

GPC England advises that practices do not have to sign up to local neighbourhood proposals and should not be pressured to, while national proposals are still being consulted on.

Engage early

General practice should help shape the local model, not just receive it. Agree with your PCN what you would offer and what you would need.

Share it with us first

Send local proposals to BLMC before you commit. We will respond promptly and tell you how they compare with our position. Tell us if you feel under pressure to sign.

What is changing

The 10 Year Health Plan aims to move care from hospital into the community through a Neighbourhood Health Service. NHS England has proposed two new contracts to deliver it: the single neighbourhood provider (SNP) and the multi neighbourhood provider (MNP).

  • Your core contract: GMS, PMS and APMS are outside the consultation and continue to fund core general practice.
  • Size: A neighbourhood is typically around 50,000 people. A multi neighbourhood provider would usually cover around 250,000 or more. Footprints can vary locally.
  • Funding: NHS England says there is no new national funding for these contracts. ICBs would fund them from local budgets.
  • PCN funding: Under the proposals, if practices move from the PCN DES to a single neighbourhood provider, investment must be at least equal to the PCN DES, including ARRS staff.

How the proposed contracts fit together

Integrated care boardCommissions core general practice and any neighbourhood contracts, funded from local budgets.
Stays as it isCore general practice

GMS, PMS and APMS contracts, held by your practice. Not part of the consultation.

ProposedSingle neighbourhood provider

One neighbourhood of around 50,000 people. An evolution of the PCN DES. Three possible routes:

  1. A local variation of the PCN DES, with PCN agreement
  2. The ICB commissions each provider directly
  3. The ICB commissions a multi neighbourhood provider, which subcontracts
ProposedMulti neighbourhood provider

Several neighbourhoods, around 250,000 people or more. Could be a primary care organisation, a limited partnership, a community interest company or an NHS trust. Two options:

  1. Coordinates delivery while existing contracts stay with the ICB
  2. Lead provider that holds the contract and subcontracts to others

Source: NHS England consultation on proposed contracting models, 2026. Proposals may change after the next consultation.

Where we stand

Where the BMA and GPC England stand

  • Contract models: The BMA opposes integrated health organisations and the multi neighbourhood provider model. It sees single neighbourhood providers as less of a threat to the partnership model, provided essential safeguards are secured.
  • Who runs general practice: The BMA sees general practice run by secondary care as a serious risk to the partnership model.
  • Safeguards: The BMA asks for community capacity to be built before care moves, estates funded from public capital rather than PFI, and doctors employed on BMA standard terms.
  • GP leadership: The BMA wants neighbourhoods led locally by GPs, with GPs in central leadership and decision-making roles.

Read more: BMA on neighbourhoods and integrated health organisations and GPC England guidance and updates.

BLMC’s position on neighbourhoods

Our position follows the BMA and GPC England, applied to the needs of Birmingham practices.

What practices need from any proposal

For practices to take part with confidence, a proposal should offer:

  • GP leadership at every level, with BLMC recognised as the statutory representative body for GPs in Birmingham
  • a fair say for every practice, whatever its size or organisational model
  • GMS, PMS, DES and LES funding protected in full
  • new, protected funding for any work that moves into general practice, at the same rate whoever provides it
  • full transparency on how neighbourhood budgets are spent
  • a clear exit route if joint delivery models do not work
  • proper piloting and evaluation before anything is scaled up

What BLMC commits to

Support neighbourhood working that helps practices and patients by:

  • engaging early and constructively with the BSol GP Partnership Board, the ICB and providers
  • working with the Partnership Board to agree shared positions wherever we can
  • responding promptly to proposals shared with us
  • gathering and representing the views of practices
  • helping practices understand and put into practice what is agreed
  • raising concerns directly and in good time, before they become disputes
  • asking that practices are given time to consider local proposals while the national ones are still being developed

Neighbourhoods in Birmingham

Who does what locally

Where the contract and the money flow

Commissions

Integrated care boardSets the model and the budget. Should involve the LMC on anything affecting practices.

Hosts

Anchor or host organisationHolds or coordinates a neighbourhood contract. It could be a trust or a vehicle owned by general practice.

Deliver

Practices and PCNsProvide the care. Decide whether to take part.

Who speaks for general practice

Leads

BSol GP Partnership BoardShapes what general practice offers the system and how neighbourhood services are designed.

Represents

Birmingham LMCThe statutory representative of GPs and practices on anything that binds them: contracts, funding and liability.

Practices are best served when general practice speaks with an aligned voice. The Partnership Board and the LMCs agree shared positions wherever they can, and each keeps its own mandate. BLMC stays independent and accountable to the GPs who elect it.

Integrated neighbourhood teams (INTs)

Integrated neighbourhood teams are how neighbourhood health works day to day. An INT is not a contract or an organisation: it is a team of professionals from different services working together for the same local population, usually 30,000 to 50,000 people. Whichever contract model is chosen, the INT is the team that delivers the care.

BLMC’s view: you do not have to form or join an INT. There is no national contract or specification for INTs, and NHS England’s neighbourhood guidelines are deliberately permissive. Taking part is not a requirement of the GMS, PMS or APMS contract. Check your PCN DES and any local enhanced service specification before agreeing to anything, and do not let anyone pressure your practice into committing. Tell us at birmingham.lmc@nhs.net if you are being pushed.

What an INT does

  • Who is in it: GPs and practice teams, community nursing and therapies, mental health, pharmacy, social care and voluntary services.
  • Who it is for: mainly people with complex needs. NHS England estimates around 7% of the population accounts for nearly half of hospital costs.
  • How it works: shared case reviews, a named care coordinator for each person, and joined-up records.
  • Where it fits: NHS England’s neighbourhood health guidelines make multidisciplinary teams one of six core parts of neighbourhood health, alongside population health management, modern general practice, community services, intermediate care and urgent neighbourhood care.

INTs in Birmingham and Solihull

  • Started 2023: accelerator teams in east and west Birmingham, followed by INTs for the north, south, east, west and central localities.
  • Growing: 11 more teams being set up from 2025 (nine in Birmingham, two in Solihull), with an ambition to cover all 35 neighbourhoods.
  • Early results: an initial evaluation at the East Birmingham Locality Hub reported 30% fewer A&E attendances and 14% shorter hospital stays.
  • Local push: the ICB and community trust are expanding INTs, but this is a local programme, not a contractual requirement. Ask for any proposal, its funding and its timescale in writing, and share it with BLMC.

If your practice chooses to take part

  • Funding and backfill: GP and staff time in INT meetings should be paid at a fair rate, with backfill. Ask who funds it and for how long.
  • Terms for GPs: the BMA says sessional GPs in neighbourhood roles should be employed on at least the BMA salaried model contract terms.
  • Clinical responsibility: be clear who is responsible for each patient discussed and who acts on the plan.
  • Data sharing: check there is a data sharing agreement and DPIA before sharing records.
  • No hidden transfer: INT work should not become unfunded work moved to practices. If it does, report it using the interface concerns form.
  • GP leadership: BLMC and the BMA want neighbourhoods led locally by GPs. Tell us if GPs are not involved in decisions about your INT.

Sources: NHS England neighbourhood health guidelines 2025/26; Birmingham Community Healthcare news, September 2023 and July 2025; BMA on neighbourhoods.

How working together gets stronger

InertiaPerformance

Entry

Agree to work togetherPartners come to the table.

Functioning

Clear roles and rulesWho decides what, and how differences are handled.

Synergy

More together than apartEach partner adds something the others cannot.

Effectiveness

Results practices can seeBetter services, fairly funded.

Trust moves a partnership along this path. It grows with each small shared success and falls when problems go unresolved, so partnerships can slip back as well as move forward. Adapted from Aunger and colleagues, Systematic Reviews, 2021.

Questions to ask

Prompts, not conditions. Use the ones that fit, and ask for the answers in writing.

For the ICB

  1. Which route is proposed: a PCN DES variation, or a single or multi neighbourhood provider?
  2. Are our PCN DES, ARRS and core funding protected, in writing?
  3. Is the neighbourhood funding new, and how long is it committed for?
  4. What work moves into general practice, and what funding and staff come with it?
  5. How long do practices have to decide, and how has the LMC been involved?

For the host organisation

  1. Who holds the contract, and who is accountable if things go wrong?
  2. What say do practices have in decisions, including smaller practices?
  3. How much is kept for management, and what happens to any surplus?
  4. Who employs the staff, who carries the liabilities, and what patient data is needed?
  5. How does a practice leave, and what happens to staff and funding if it does?

For your practice or PCN

  1. Can we do this safely alongside our core work?
  2. Does the funding cover the full cost, including premises and management time?
  3. What exactly are we signing, and for how long?
  4. What happens to our staff and patients if the funding stops?
  5. Have we shared the proposal with BLMC?

Will the money follow the work?

Moving care closer to home is often expected to pay for itself. The evidence says it rarely does on its own.

The three shifts

The 10 Year Health Plan rests on three shifts in how the NHS works. Neighbourhood health is mainly about the first.

Hospital communityMore care delivered in neighbourhoods, closer to home.89 interventions reviewed
Analogue digitalOnline access, the NHS App and other digital tools.126 interventions reviewed
Sickness preventionHealth checks, vaccination, screening and lifestyle support.122 interventions reviewed
of 337 interventions were shown to release cash

A 2026 evidence review by the NHS Health Economics Unit looked at 186 research papers and 151 other documents from 2019 to 2025. It found 337 interventions across the three shifts. Most had the potential to release cash if the right conditions were in place, but none met all five of the authors’ tests for cash actually being released. Explore every intervention in the HEU and HFMA evidence map.

That matters for general practice. If new work arrives on the promise of savings elsewhere, those savings may never reach the community as money. Ask how and when they will be turned into cash, and what happens to the funding if they are not.

Why moving care out of hospital doesn’t free up money on its own

Care movesWork shifts from hospital to the community.
Activity fallsFewer admissions or shorter stays.
The gain is absorbedBeds stay open, staff are redeployed, capacity refills.
The money does not moveContracts and budgets stay the same.

For money to actually be freed up, all five must be true

1The budget goes downActual spend or the budget allocation is reduced.
2There is a clear routeA specific way to take the money out of the baseline.
3It can be measuredA baseline and a comparison to check the change against.
4It lastsSavings recur in-year and beyond, not one-off or deferred.
5No hidden costsCosts do not move elsewhere and care does not get worse.

Tests from Finlay and colleagues, Future Healthcare Journal, 2026. The review also sets out the conditions that make cash release possible, from budget and workforce changes to governance and measurement.

Useful openers with finance colleagues

  • Where does failure in primary, community or social care drive avoidable hospital cost, and can we map it together?
  • Which hospital activity is low value, or better done closer to home?
  • If that activity stops, how much is truly cash releasing and how much is left behind as fixed cost?
  • What would you need to see, and by when, to trust that it is working?
  • Where services are expanding, where would extra investment achieve the most, and would the same money go further in the community?

What to do now

  • Talk to your PCN and neighbouring practices. Agree what you would offer and what you would need.
  • Do not sign under pressure. Ask for the proposal, the funding and the timescale in writing.
  • Test it. Use the questions on this page.
  • Share it with BLMC before you commit. Email birmingham.lmc@nhs.net.
  • Measure from day one. Agree the baseline and what counts as success before you start.

Last updated October 2026. The national proposals are still under consultation and may change. This page is general guidance for practices, not legal or financial advice. We will update it when NHS England publishes its next proposals. Questions or a proposal to share: birmingham.lmc@nhs.net